Treatment of Unique Bilateral Distal Fusiform Superior Cerebellar Artery Aneurysms with Mini-Flow Diverter Device Implantation: Case Report

2021 ◽  
Author(s):  
Björn B. Hofmann ◽  
Christian Rubbert ◽  
Bernd Turowski ◽  
Daniel Hänggi ◽  
Sajjad Muhammad
Keyword(s):  
Flow Diverter ◽  
Superior Cerebellar Artery ◽  
World Federation ◽  
Excellent Outcome ◽  
Small Vessels ◽  
Device Implantation ◽  
Rescue Treatment ◽  
Fisher Grade ◽  
Cerebellar Artery ◽  
Revascularization Procedures

AbstractCurrently, surgical revascularization procedures using intracranial–intracranial (IC-IC) or extracranial–intracranial (EC-IC) bypass and distal clipping or trapping are the valid and rescue treatment modality for extremely rare unilateral distal fusiform superior cerebellar artery (SCA) aneurysms. Yet, in case of bilateral fusiform SCA aneurysms, surgical therapy reaches its limit. Mini-flow diverter devices (FDDs) have only recently become available for treating fusiform aneurysms of such small vessels. We report the unique case of bilateral distal fusiform SCA aneurysms in a 43-year-old man with subarachnoid hemorrhage (Fisher grade IV and World Federation of Neurosurgical Societies [WFNS] grade II) treated with endovascular implantation of bilateral mini-FDDs with excellent outcome and no radiographic signs of infarction. Yet, occlusion of one of the FDDs was found in the follow-up, which again shows the eminent danger of occlusion in case of an implantation of FDDs in such small-caliber vessels, which leaves the discussion about the optimal therapy method open.

scholarly journals Endovascular Treatment of a Small Aneurysm of the Superior Cerebellar Artery with a Flow-Diverter Device

2013 ◽  
Vol 26 (3) ◽  
pp. 327-331 ◽  
Author(s):  
F. Briganti ◽  
M. Marseglia ◽  
G. Leone ◽  
G. Briganti ◽  
D. Piccolo ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Flow Diverter ◽  
Superior Cerebellar Artery ◽  
Cerebellar Artery ◽  
Small Aneurysm ◽  
Flow Diverter Device

Abstract 12: Buenos Aires Experience With Flow Diverter in our First 1000 Patients Safety, Efficacy and Long Term Follow-up

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Javier Lundquist ◽  
Angel Ferrario ◽  
Rosana Ceratto ◽  
Esteban Scrivano ◽  
Jorge Chudyk ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Previous Treatment ◽  
Mass Effect ◽  
Flow Diverter ◽  
Superior Cerebellar Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Cerebellar Artery ◽  
Long Term Follow Up

Background: Hemodynamic flow is one of the major factors in the progression and rupture of intracranial aneurysms (IA). Flow diverter devices (FD) reduce blood flow in the aneurysm sac, allow gradual stagnation, thrombosis and neointimal remodeling while maintain outflow in the side branches and perforators. Objectives: We present our experience and long-term follow-up on endovascular reconstruction of complexes IA using flow diverter device. Particularly we analyze our experience with (Pipeline endovascular device) PED. Methods: Since March 2006 to July 2015, 1000 patients (pt) with IA were treated with FD or FD/coils. Of this group 633 pt were with PED, 113 Surpass (SNEG), 111 P64, 78 Cardiatis, 40 WEB and others 25. Angiographic follow-up was performed at 3, 6, 12 months and yearly until 8 y Fup. An inclusion criteria was unfavorable anatomy for coil, dome to neck ratio ≥ 2, Neck ≥ 4 mm and recurrence following previous treatment. Results: We treated 633 Pt with 704 IA with 932 PED. (77 % female); mean age 55 y (range 7-88). History of SAH was present in 18,5%; 81,5% were unruptured IA; mass effect in 125 pt; incidental IA 96 pts; headache 77 pts, others 23 pts. Large/giant IA were present in 51,2%, and wide neck (>4mm) 65%. The technical success was 98,4%. Occlusion rate at 1yr was 90 % and 8 yr 100 %, without recurrences. Peri-procedural (30 days) morbi-mortality rate was 5.9%: 2.7% had definitive neurologic defects; death rate was 3.2%. Conclusion: Endovascular treatment of complex IA with FD is a safe, effective and stable procedure, with an acceptable morbi-mortality rate. Abbreviations: AICA, anterior inferior cerebellar artery • BA, basilar artery • DSA, digital subtraction angiography • IA, intracranial aneurysm • ICA, internal carotid artery • MRA, MR angiography • PcomA, posterior communicating artery • PED, Pipeline • SNEG, Surpass •Embolization Device • SAH, subarachnoid hemorrhage • SCA, superior cerebellar artery

Acute Treatment of Ruptured Fusiform Posterior Circulation Posterior Cerebral, Superior Cerebellar, and Posterior Inferior Cerebellar Artery Aneurysms With FRED Flow Diverter: Report of 5 Cases

2018 ◽  
Vol 16 (5) ◽  
pp. 549-556 ◽  
Author(s):  
Dan Laukka ◽  
Riitta Rautio ◽  
Melissa Rahi ◽  
Jaakko Rinne
Keyword(s):  
Treatment Time ◽  
Brain Infarction ◽  
Treatment Options ◽  
Posterior Inferior Cerebellar Artery ◽  
Flow Diverter ◽  
External Ventricular Drainage ◽  
Posterior Circulation ◽  
Superior Cerebellar Artery ◽  
Technical Success Rate ◽  
Cerebellar Artery

Abstract BACKGROUND Flow diverter (FD) treatment of ruptured fusiform posterior cerebral artery (PCA), posterior inferior cerebellar artery (PICA), and superior cerebellar artery (SCA) aneurysms are limited to single reports. OBJECTIVE To study the safety and efficacy of FD treatment for ruptured fusiform aneurysms of the PCA, SCA, and PICA. METHODS Five patients with ruptured posterior circulation fusiform aneurysms and treated with a Flow-Redirection Endoluminal Device (FRED/FRED Jr; Microvention, Tustin, California) stent in the acute phase of subarachnoid hemorrhage between 2013 and 2016 were included and reviewed retrospectively. RESULTS Two aneurysms located on the PICA, 2 on PCA, and 1 on the SCA. Mean treatment time with FD was 5.8 d (range, 0-11 d) from ictus. The technical success rate was 100%. On admission 2 patients were Hunt and Hess grade 1, 2 patients grade 3, and 1 patient grade 4. At discharge, 4 patients (80%) were independent (modified Ranking Scale (mRS) ≤2) and 1 patient had severe disability (mRS 4). None of the patients had aneurysmal rebleeding. All 5 aneurysms were completely occluded on angiographic follow-up (range, 3-22 mo). One patient had permanent intraprocedural in stent thrombosis and brain infarction. One patient had spontaneous nonaneurysmal intracerebral hemorrhage 1 mo after FD treatment. External ventricular drainage was inserted in 3 patients and ventriculoperitoneal shunt in 2 patients without hemorrhagic complications despite dual antiplatelet therapy. CONCLUSION FD could be considered as a treatment option for ruptured fusiform aneurysms located on PCA, PICA, or SCA when other treatment options are challenging.

Variation in Patient Characteristics and Outcomes Between Early and Delayed Surgery in Poor-Grade Aneurysmal Subarachnoid Hemorrhage

Neurosurgery ◽  
2015 ◽  
Vol 78 (2) ◽  
pp. 224-231 ◽  
Author(s):  
Bing Zhao ◽  
Xianxi Tan ◽  
Yuanli Zhao ◽  
Yong Cao ◽  
Jun Wu ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Patient Characteristics ◽  
Early Surgery ◽  
World Federation ◽  
Poor Grade ◽  
Excellent Outcome ◽  
Delayed Surgery ◽  
Fisher Grade ◽  
Middle Cerebral Artery Aneurysms

ABSTRACT BACKGROUND: There is no consensus regarding the optimal timing for surgery for poor-grade aneurysmal subarachnoid hemorrhage. OBJECTIVE: To retrospectively evaluate variation in patient characteristics and outcomes between early and delayed surgery groups. METHODS: Poor-grade aneurysmal subarachnoid hemorrhage was defined as a World Federation of Neurosurgical Societies grade of IV or V after resuscitation. Early surgery was defined as surgery performed within 72 hours of ictus, and delayed surgery was defined as surgery after 72 hours. Outcomes were assessed by modified Rankin score. The mean time of follow-up was 12.5 ± 3.4 months. RESULTS: Of the 118 patients included in the study, 80 (68%) underwent early surgery and 38 (32%) underwent delayed surgery. Patients with brain herniation (P < .001) and a lower Fisher grade (P = .02) more often underwent early surgery. Patients in the early group more often underwent decompressive craniectomy (P < .001). Postoperative complications and length of hospital stay did not differ, and outcomes were similar between the 2 groups. Forty (34%) patients had an excellent outcome (modified Rankin score 0-1). Multivariate analysis showed a slight trend toward an excellent outcome in the early surgery group. Younger age, World Federation of Neurosurgical Societies grade IV after resuscitation, and middle cerebral artery aneurysms were independent predictors of an excellent outcome. CONCLUSION: Although patients with brain herniation and a lower Fisher grade were more likely to undergo early surgery, there was a slight trend toward an excellent outcome in the early surgery group. Patients with a younger age, World Federation of Neurosurgical Societies grade IV after resuscitation, and middle cerebral artery aneurysms were more likely to experience an excellent outcome.

scholarly journals Perforating Arteries of the Lemniscal Trigone: A Microsurgical Neuroanatomic Description

2021 ◽  
Vol 15 ◽  
Author(s):  
Santino Ottavio Tomasi ◽  
Giuseppe Emmanuele Umana ◽  
Gianluca Scalia ◽  
Roberto Luis Rubio-Rodriguez ◽  
Giuseppe Raudino ◽  
...  
Keyword(s):  
Vascular Malformations ◽  
Superior Cerebellar Artery ◽  
Pathological Lesions ◽  
Small Vessels ◽  
Cerebellar Artery ◽  
Microsurgical Approach ◽  
Midbrain Tumors ◽  
Tentorial Incisura ◽  
Digital Caliper ◽  
Perforating Arteries

Background: The perforating arteries in the dorsolateral zone of the midbrain play a crucial role in the functions of the brain stem. Their damage due to herniation, pathological lesions, or surgery, favored by the narrow tentorial incisura, can lead to hemorrhages or ischemia and subsequently to severe consequences for the patient.Objective: In literature, not much attention has been directed to the perforating arteries in the lemniscus; in fact, no reports on the perforators of this anatomical region are available. The present study aims to a detailed analysis of the microanatomy and the clinical implications of these perforators, in relation to the parent vessels. We focused on the small vessels that penetrate the midbrain's dorsolateral surface, known as lemniscal trigone, to understand better their microanatomy and their functional importance in the clinical practice during the microsurgical approach to this area.Methods: Eighty-seven alcohol-fixed cadaveric hemispheres (44 brains) without any pathological lesions provided the material for studying the perforating vessels and their origin around the dorsolateral midbrain using an operating microscope (OPMI 1 FC, Zeiss). Measurements of the perforators' distances, in relation to the parent vessels, were taken using a digital caliper.Results: An origin from the SCA could be found in 70.11% (61) and from the PCA in 27.58% (24) of the hemispheres. In one hemisphere, an origin from the posterior choroidal artery was found (4.54%). No perforating branches were discovered in 8.04% of specimens (7).Conclusion: The perforating arteries of the lemniscal trigone stem not only from the superior cerebellar artery (SCA), as described in the few studies available in literature, but also from the posterior cerebral artery (PCA). Therefore, special attention should be paid during surgery to spare those vessels and associated perforators. A comprehensive understanding of the lemniscal trigone's perforating arteries is vital to avoid infarction of the brainstem when treating midbrain tumors or vascular malformations.

scholarly journals Successful rescue treatment of right posterior inferior cerebellar artery (PICA) vascular stasis with tirofiban following endovascular coil implantation

2021 ◽  
Vol 14 (1) ◽  
pp. e238120
Author(s):  
Christopher Houle ◽  
Varun Reddy
Keyword(s):  
Hospital Stay ◽  
Continuous Infusion ◽  
Posterior Inferior Cerebellar Artery ◽  
Neurological Deficits ◽  
Antiplatelet Treatment ◽  
Fixed Rate ◽  
Rescue Treatment ◽  
Cerebellar Artery

This report describes a patient who developed intraprocedural vascular stasis immediately following elective endovascular coil emboliation. Urgent antiplatelet treatment with the GpIIb/IIIa agent tirofiban was used. It was infused intra-arterially during the procedure, followed by a fixed rate intravenous continuous infusion, and successfully restored normal circulation. There were no reports of further bleeding or haemodynamic compromise during the hospital stay. The patient’s condition returned to baseline and he was discharged the following day with no neurological deficits.

Efficacy of carbamazepine on cerebellar tremors in patients with superior cerebellar artery syndrome

1989 ◽  
Vol 236 (8) ◽  
pp. 461-463 ◽  
Author(s):  
G. P. Sechi ◽  
A. Pirisi ◽  
V. Agnetti ◽  
M. Piredda ◽  
M. Zuddas ◽  
...  
Keyword(s):  
Superior Cerebellar Artery ◽  
Cerebellar Artery
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